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About the Role

The Compliance Specialist supports the organization’s Corporate Compliance Program by promoting adherence to applicable federal and state laws, regulations, payer requirements, and organizational policies. This position assists in the development, implementation, and ongoing maintenance of an effective compliance program with a particular focus on Medicaid compliance, billing integrity, auditing, staff education, risk assessment, and regulatory preparedness.

Responsibilities

Supports the ongoing maintenance of the organization’s Corporate Compliance Program.
Assists in ensuring organizational compliance with Medicaid, OMH, OCFS, and other applicable federal and state regulatory requirements.
Participates in organizational compliance and risk assessment activities to identify areas of potential vulnerability and recommends mitigation strategies.
Assists with the development, review, and revision of compliance-related policies and procedures, internal controls, and assessments and audit tools.
Serves as a key participant on the organization’s compliance committee, and other quality improvement committees as appropriate.
Conducts billing, claims, and documentation audits to assess compliance with Medicaid and payer requirements, organizational policies, and regulatory standards.
Monitors audit findings, track corrective action plans, and support follow-up activities to ensure resolution of identified issues.
Assists with internal and external compliance reviews, audits, investigations, and regulatory inquiries.
Delivers compliance-related training and education materials for employees, leadership, contractors, and other stakeholders.
Promotes awareness of compliance expectations, reporting obligations, and ethical standards throughout the organization.
Supports the intake, tracking, documentation, and follow-up of compliance concerns, complaints, and reports.
Assists the Director of QAI and Compliance in compliance-related investigations.
Assists the department with reviewing and evaluating records requests, and collects and provides documentation as appropriate.
Maintains compliance tracking systems, records, and documentation in accordance with organizational and regulatory requirements.
Remains abreast of regulatory updates and changes, and attends trainings and conferences as required.
Prepares reports, summaries, and compliance metrics for leadership, committees, and regulatory purposes.
Performs other duties as assigned by the Director of Quality Assurance and Compliance.

Requirements

Bachelor’s degree in public or healthcare administration, human services, compliance or a related field with at least two (2) years experience OR an Associates degree/certifications/experience with a minimum of (5) years in healthcare compliance, auditing, quality assurance or regulatory work.

Skills

Medicaid compliance
Billing integrity
Auditing
Risk assessment
Regulatory preparedness
Compliance committee participation
Policy and procedure development
Internal controls
Audit tools
Billing audits
Claims audits
Documentation audits
Corrective action plans
Compliance reviews
Compliance audits
Compliance investigations
Regulatory inquiries
Compliance training delivery
Compliance reporting
Record requests evaluation
Compliance tracking systems
Regulatory updates monitoring

Location

Poughkeepsie, NY

Work Type

Full Time
Onsite

Experience Level

2+ years experience with Bachelor's degree
5+ years experience with Associate's degree/certifications

Education Level

Bachelor's Degree
Associate's degree
Certifications
Master's degree (preferred)
Compliance certification (preferred)

Salary/Compensations

$28.00 - $33.00 Hourly

Benefits

Medical insurance
Vision insurance
Dental insurance
Life insurance
403(b)
Tuition reimbursement
Paid time off (4 weeks vacation, 3 personal days, 12 holidays, 9 sick days)

About the Company

The Children's Home of Poughkeepsie has been caring for children throughout the Hudson Valley for over 175 years!
We strive to empower children and families to achieve optimal health and well being.
This position operates within a nonprofit organization serving youth ages 5–21 who may be experiencing mental health challenges, family instability, risk of sex trafficking, or risk of foster care placement.
Programs are subject to oversight by the New York State Office of Mental Health (OMH), Office of Children and Family Services (OCFS), and other applicable regulatory agencies.

Equal Opportunity

The Children's Home of Poughkeepsie is an Equal Opportunity Employer.
The Children's Home participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.